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Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006
Consumer Contact Record File Specifications
NOVEMBER 2006
Version 1.1 Table of Contents
1.0 Changes from the Previous Version ..............................................................................2 2.0 File Name.......................................................................................................................2 3.0 Delimiters.......................................................................................................................4 4.0 Fields..............................................................................................................................4
4.1 Label Fields......................................................................................4 4.2 Data Fields .......................................................................................4 4.3 Multiple Value Fields ......................................................................5
5.0 Sample Record ...............................................................................................................6 6.0 File Layout .....................................................................................................................7 7.0 File Transfer and Retrieval ..........................................................................................21 Appendix A - Submitter ID Table .....................................................................................23 Appendix B - County Code Table .....................................................................................24 Appendix C - Assignment Code Table ..............................................................................25 Appendix D - CRISE Enrollment Table Reason Codes ....................................................27
Appendix E - CRISE Disenrollment Table Reason Codes ...............................................28 Appendix F - Change Reason Codes .................................................................................30 Appendix G - Primary Language Indicator Table .............................................................31 Appendix H - Condition Code Table .................................................................................34 Appendix I - Relationship Table.......................................................................................36
This document describes the file formats and record layouts to be used for the consumer contact record submissions for managed care plans (MCPs).
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 2
1.0 Changes from the Previous Version
1.1 File name changed from ECMP to ABD MCP; ECMP files names were deleted. File names will reflect whether the file contains ABD MCP versus CFC MCP consumer contact records.
1.2 ECMP references have been deleted from the Field descriptions. 1.3 TYPEOFENROLL no longer includes selection codes 05 and 06 (ECMP references).
1.4 CRISE Reason Data Field is now a required field. 1.5 Appendix A (Submitter ID Table) has been updated.
1.6 Appendix C (Assignment Code Table) has been updated to reflect the ABD program. 1.7 Appendix D (CRISE Reason Code Table) has been revised to include CRISE
Enrollment Reason Code table and to delete ECMP reason code tables. Appendix D will only reflect the Enrollment reason codes.
1.8 Appendix E (Change Reason Codes Table) is now, CRISE Disenrollment Reason
Code Table. 1.9 Appendix F (Primary Language Indicator Table) is now the Change Reason Code
Table. 1.10 Appendix G (Condition Code Table) is now the Primary Language Indicator Table
which has been updated to include the country. 1.11 Appendix H (Relationship Table) is now the Condition Code Table. The Condition
Code Table has been updated to include ABD conditions. 1.12 Appendix I is the Relationship Table.
2.0 File Name The file name for CFC MCP’s consumer contact records contains a unique characters identifying the file type, submitter’s ID, month and year of submission.
exxxmmyy.t00
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 3
Position
Symbol
Description
1
e
>e= Indicates CFC MCP selection file
2-4
xxx
MCP Submitter ID (Use codes from Appendix A)
5-8
mmyy
mm Month of submission yy Year of submission
9-11
.t00
Extension: t >t= represents a text file 00 >00' is the number of text file submission for the
month. Increment by 1 with each new file submission. First file submission for each month begins with >00', the next >01', etc.
The file name for ABD MCP’s consumer contact records contains a unique character identifying the file type, submitter’s ID, month and year of submission.
fxxxmmyy.t00
Position
Symbol
Description
1
f
>f= Indicates ABD MCP selection file
2-4
xxx
MCP Submitter ID (Use codes from Appendix A)
5-8
mmyy
mm Month of submission yy Year of submission
9-11
.t00
Extension: t >t= represents a text file 00 >00' is the number of text file submission for the
month. Increment by 1 with each new file submission. First file submission for each month begins with >00', the next >01', etc.
Example: File name for the first consumer contact record file submission for
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 4
June 2001 for an MCP:
exxx0601.t00
The next file for June would be:
exxx0601.t01
3.0 Delimiters The delimiters are as follows:
This delimiter symbol:
Is this character:
Means this:
|
Bar
End of a label field
~
Tilde
End of a data field
,
Comma
Separates multiple values within a data field
Note: No spaces should be inserted between the field label, tilde character, and bar character.
4.0 Fields
4.1 Label Fields
Label fields are fields that identify the data in the following field. A label field precedes each data field (see sample record in section 5.0). Label fields are standard for delimited files. The specifications for these fields are included in Table 1 and Table 2.
Note: All label fields must be included in the record, even if the corresponding data fields contain no data.
4.2 Data Fields
Data fields are fields that contain the value for each data item.
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 5
If no data is available for a data field:
Insert a tilde character (~) immediately after the field label and bar character (|).
Then, continue with the next field. For example, the format of an consumer contact record with no zip+4 is as follows:
P4ZIP3|~COUNTY|01~
4.3 Multiple Value Fields
The fields in which multiple values can be entered are as follows:
$ Screening for Medical Condition Code $ Screening for Additional Assistance Code
Example: The chronic medical problem is leukemia (condition code = 04) and pregnancy (condition code = 30). These data fields would appear as follows in the record layout:
~MEDSCRNRESULT|04,30~
There is a section within the layout that allows for multiple consumers to be entered. The format for multiple consumers is to continue to repeat the label / data combination for each consumer.
Example: AGMLANG|ENG~LASTNAME|GESS~FIRSTNAME|MARY~MI|B~RSHIP|SAM~SEX|F~ADDINFO1|W~ADDINFO2|N~BDATE|12/03/1970~MEDRECIPIENTID|104012734699~DESPCP|ST VINCENTS PCP CLINIC~DESPCPMEDPROVNO|4876309~CRTPCPPAT|F~DESHOSP|ST VINCENTS~SCREENSTATUS|01~MEDSCRNRESULT|26~OTHMEDSCRN|~NONMEDSCRNRESULT|~SSOT|T~SRVTRT|DELIVERY~SRVTRTDATE|12/12/2000~SRVTRTDOC|ST VINCENTS CLINIC~AGMLANG|ENG~LASTNAME|GESS~FIRSTNAME|MEGAN~MI|E~RSHIP|DAU~SEX|F~ADDINFO1|W~ADDINFO2|N~BDATE|12/07/1993~MEDRECIPIENTID|103012733299~DESPCP|DR.WAUGH~DESPCPMEDPROVNO|3456753~CRTPCPPAT|F~DESHOSP|ST.VINCENTS~SCREENSTATUS|02~MEDSCRNRESULT|~OTHMEDSCRN|~NONMEDSCRNRESULT|~SSOT|F~SRVTRT|~SRVTRTDATE|~SRVTRTDOC|~
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 6
5.0 Sample Record
The following example record includes three members of an assistance group being assigned to an MCP. Please note the field label >AGMLANG= is bolded for illustrative purposes only. This field marks the beginning of data that is repeated for each consumer included in the record. EFFECTDATE|09/01/2000~CASENUM|5044173499~ASSISTGRPCAT|MA~ASSISTGRPSEQ|C01~LASTNAMEPIP|GESS~FIRSTNAMEPIP|MARY~AREACODEPIP|330~PHONEPIP|4765715~SSNPIP|565155545~LANGPIP|ENG~AREACODE1|330~PHONE1|4765715~AREACODE2|~PHONE2|~AREACODE3|~PHONE3|~ADDRESS1A|~ADDRESS1B|~CITY1|~STATE1|~ZIP1|~P4ZIP1|~ADDRESS2A|1234 STATER DR #101~ADDRESS2B|~CITY2|AKRON~STATE2|OH~ZIP2|44221~P4ZIP2|~ADDRESS3A|~ADDRESS3B|~CITY3|~STATE3|~ZIP3|~P4ZIP3|~ADDRESS4A|~ADDRESS4B|~CITY4|~STATE4|~ZIP4|~P4ZIP4|~COUNTYNO|77~TYPEOFENROLL|02~ASSIGNCODE|01~MCPMEDPROVNO|~NEWMCPMEDPROVNO|2014568~CRISEDISREASON|~CHREASON|~OCHREASON|~AGMLANG|ENG~LASTNAME|GESS~FIRSTNAME|MARY~MI|B~RSHIP|SAM~SEX|F~ADDINFO1|W~ADDINFO2|N~BDATE|12/03/1970~MEDRECIPIENTID|104012734699~DESPCP|ST VINCENTS PCP CLINIC~DESPCPMEDPROVNO|4876309~CRTPCPPAT|F~DESHOSP|ST VINCENTS~SCREENSTATUS|01~MEDSCRNRESULT|26~OTHMEDSCRN|~NONMEDSCRNRESULT|~SSOT|T~SRVTRT|DELIVERY~SRVTRTDATE|12/12/2000~SRVTRTDOC|ST VINCENTS CLINIC~AGMLANG|ENG~LASTNAME|GESS~FIRSTNAME|MEGAN~MI|E~RSHIP|DAU~SEX|F~ADDINFO1|W~ADDINFO2|N~BDATE|12/07/1993~MEDRECIPIENTID|103012733299~DESPCP|DR.WAUGH~DESPCPMEDPROVNO|3456753~CRTPCPPAT|F~DESHOSP|ST.VINCENTS~SCREENSTATUS|02~MEDSCRNRESULT|~OTHMEDSCRN|~NONMEDSCRNRESULT|~SSOT|F~SRVTRT|~SRVTRTDATE|~SRVTRTDOC|~AGMLANG|ENG~LASTNAME|GESS~FIRSTNAME|GARY~MI|G~RSHIP|HUS~SEX|M~ADDINFO1|W~ADDINFO2|N~BDATE|12/03/1965~MEDRECIPIENTID|102012238699~DESPCP|ST VINCENTS PCP CLINIC~DESPCPMEDPROVNO|3938420~ CRTPCPPAT|F~DESHOSP|ST VINCENTS ~SCREENSTATUS|01~MEDSCRNRESULT|02,21~OTHMEDSCRN|~NONMEDSCRNRESULT|~SSOT|T~SRVTRT|HEART BYPASS SURGERY~SRVTRTDATE|09/23/2000~SRVTRTDOC|ST VINCENTS CLINIC~OPOLICYINAME|~OPOLICYINUM|~ERCLASTNAME|GESS~ERCFIRSTNAME|MARY~ERCRSHIP|SAM~ERCHACODE|330~ERCHPHONE|4744714~ERCBACODE|330~ERCBPHONE|8473625~AUTHTOTRT|T~CALLERLASTNAME|GESS~CALLERFIRSTNAME|MARY~ENRSPECID|556451234~CONTACTDATE|08/08/2000~PROCDATE|08/08/2000~PROCBYID|213459632~
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 7
6.0 File Layout
Field Type
Field Name
Required, Conditional, Optional
Description
Label
EFFECTDATE
R
EFFECTDATE
Data
Effective Date
R
Date selection/termination becomes effective, Format: MM/DD/YYYY
Label
CASENUM
R
CASENUM
Data
Case Number
R
Case Number to which the Assistance Group belongs
Label
ASSISTGRPCAT
R
ASSISTGRPCAT
Data
Assistance Group Category
R
Assistance Group Category
Label
ASSISTGRPSEQ
R
ASSISTGRPSEQ
Data
Assistance Group Sequence
R
Assistance Group Sequence
Label
LASTNAMEPIP
R
LASTNAMEPIP
Data
Last Name of the PIP
R
Last name of the primary information person (PIP) for the assistance group
Label
FIRSTNAMEPIP
R
FIRSTNAMEPIP
Data
First Name of the PIP
R
First name of the PIP for the assistance group
Label
AREACODEPIP
R
AREACODEPIP
Delimiters: l at end of label field;~ at end of data field; , separates values in a field
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 8
Data
Area Code of PIP
O
Area Code of PIP as reported by CRISE, Format: ### Note: If this number reported by CRISE is incorrect, do not include (see AREACODE1 field for the consumer-reported number).
Label
PHONEPIP
R
PHONEPIP
Data
Phone Number of PIP
O
Phone number of PIP as reported by CRISE, Format: ####### Note: If this number reported by CRISE is incorrect, do not include (see PHONE1 field for the consumer-reported number).
Label
SSNPIP
R
SSNPIP
Data
Social Security Number
O
Social Security Number of PIP, Format: #########
Label
LANGPIP
R
LANGPIP
Data
Primary language of PIP
C
Required if >Type of Selection: = 01 or 04
If >Type of Selection= = 01 or 04 and if the PIP requires interpreter services, indicate their primary language. (Use Codes from, Appendix G, Language Indicator Table)
Label
AREACODE1
R
AREACODE1
Data
Area Code
O
Area Code of residence of Assistance Group as reported by the consumer, Format: ###
Label
PHONE1
R
PHONE1
Data
Phone Number
O
Phone of residence of Assistance Group as reported by the consumer, Format: #######
Label
AREACODE2
R
AREACODE2
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 9
Data
Area Code
O
Area Code of work phone of Assistance Group Head as reported by the consumer, Format: ###
Label
PHONE2
R
PHONE2
Data
Phone Number
O
Phone of work phone of Assistance Group Head as reported by the consumer, Format: #######
Label
AREACODE3
R
AREACODE3
Data
Area Code
O
Area Code of an alternative phone for the Assistance Group as reported by the consumer, Format: ###
Label
PHONE3
R
PHONE3
Data
Phone Number
O
Phone of an alternative phone for the Assistance Group as reported by the consumer, Format: #######
Label
ADDRESS1A
R
ADDRESS1A
Data
Address line 1
R
First line of mailing address of Assistance group as reported by CRISE
Label
ADDRESS1B
R
ADDRESS1B
Data
Address line 2
R
Second line of mailing address of Assistance group as reported by CRISE
Label
CITY1
R
CITY1
Data
City
R
City of mailing address of Assistance Group as reported by CRISE
Label
STATE1
R
STATE1
Data
State
R
State of mailing address of Assistance Group as reported by CRISE
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 10
Label
ZIP1
R
ZIP1
Data
Zip
R
Zip Code of mailing address of Assistance Group as reported by CRISE (first 5 digits); Format: #####
Label
P4ZIP1
R
P4ZIP1
Data
+4 Zip
R
Last 4 digits of +4 zip code of mailing address of Assistance Group as reported by CRISE
Label
ADDRESS2A
R
ADDRESS2A
Data
Address line 1
O
Line one of residence address of the Assistance Group as reported by CRISE.
Label
ADDRESS2B
R
ADDRESS2B
Data
Address line 2
O
Line two of residence address of the Assistance Group as reported by CRISE.
Label
CITY2
R
CITY2
Data
City
O
City of residence address of the Assistance Group as reported by CRISE.
Label
STATE2
R
STATE2
Data
State
O
State of residence address of the Assistance Group as reported by CRISE.
Label
ZIP2
R
ZIP2
Data
Zip
O
Zip Code of residence address of the Assistance Group as reported by CRISE, Format: #####
Label
P4ZIP2
R
P4ZIP2
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 11
Data
+4 Zip
O
Last 4 digits of +4 zip code of residence address of the Assistance Group as reported by CRISE.
Label
ADDRESS3A
R
ADDRESS3A
Data
Address line 1
O
Line one of mailing address of the Assistance Group as reported or confirmed by the consumer or the U.S. Postal Service
Label
ADDRESS3B
R
ADDRESS3B
Data
Address line 2
O
Line two of mailing address of the Assistance Group as reported or confirmed by the consumer or the U.S. Postal Service
Label
CITY3
R
CITY3
Data
City
O
City of mailing address of Assistance Group as reported or confirmed by the consumer or the U.S. Postal Service
Label
STATE3
R
STATE3
Data
State
O
State of mailing address Assistance Group as reported or confirmed by the consumer or the U.S. Postal Service
Label
ZIP3
R
ZIP3
Data
Zip
O
Zip Code of mailing address of Assistance Group as reported or confirmed by the consumer or the U.S. Postal Service (first 5 digits), Format: #####
Label
P4ZIP3
R
P4ZIP3
Data
+4 Zip
O
Last 4 digits of +4 zip code of mailing address of Assistance Group as reported or confirmed by the consumer or the U.S. Postal Service
Label
ADDRESS4A
R
ADDRESS4A
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 12
Data
Address line 1
O
Line one of residence address of Assistance Group as reported or confirmed by the consumer
Label
ADDRESS4B
R
ADDRESS4B
Data
Address line 2
O
Line two of residence address of Assistance Group as reported or confirmed by the consumer
Label
CITY4
R
CITY4
Data
City
O
City of residence of Assistance Group as reported or confirmed by the consumer
Label
STATE4
R
STATE4
Data
State
O
State of residence of Assistance Group as reported or confirmed by the consumer
Label
ZIP4
R
ZIP4
Data
Zip
O
Zip Code of residence of Assistance Group as reported or confirmed by the consumer (first 5 digits), Format: #####
Label
P4ZIP4
R
P4ZIP4
Data
+4 Zip
O
Last 4 digits of +4 zip code of residence of Assistance Group as reported or confirmed by the consumer
Label
COUNTYNO
R
COUNTYNO
Data
County
R
2 digit county code of Assistance Group. Use codes from Appendix B, County Code Table.
Label
TYPEOFENROLL
R
TYPEOFENROLL
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 13
Data
Type of Selection
R
Choose one: 01 = New selection
02 = Assignment 03 = Change from an MCP and return to FFS 04 = Change from one MCP and select another MCP
Label
ASSIGNCODE
R
ASSIGNCODE
Data
Assignment Code
C
Required if >Type of
Selection= = 02
If >Type of Selection= = 02, choose one code from Appendix C, Assignment Code Table.
Label
MCPMEDPROVNO
R
MCPMEDPROVNO
Data
Current MCP
C
Required if >Type of
Selection= = 03 or 04
If >Type of Selection= = 03 or 04 enter 7 digit Medicaid provider number of the current MCP
Label
NEWMCPMEDPROVNO
R
NEWMCPMEDPROVNO
Data
New MCP
C
Required if >Type of
Selection= = 01, 02 or 04
If >Type of Selection= = 01, 02 or 04 enter 7 digit Medicaid provider number of the new MCP
Label
CRISEDISREASON
R
CRISEDISREASON
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 14
Data
CRISE Reason
R
Choose one CRISE Reason Code from Appendix D, CRISE Enrollment Reason Code Table or Appendix E, CRISE Disenrollment Reason Code Table
Label
CHREASON
R
CHREASON
Data
Change Reason
C
Required if >Type of
Selection= = 03 or 04
If >Type of Selection= = 03 or 04 this will indicate the reason for the change. Choose one from Appendix F, Change Reason Code Table
Label
OCHREASON
R
OCHREASON
Data
Other Change Reason
O
If >Change Reason= = 99, indicate the reason for the change with text
Label
AGMLANG
R
AGMLANG
Data
Primary Language Indicator of Assistance Group Member
C
Required if >Type of
Selection = = 01 or 04
If >Type of selection= = 01 or 04 Primary language of Assistance Group member selection/termination. Use codes from Appendix G, Primary Language Indicator Table
Label
LASTNAME
R
LASTNAME
Data
Last Name
R
Last Name of Assistance Group member selecting/terminating
Label
FIRSTNAME
R
FIRSTNAME
Data
First Name
R
First Name of Assistance Group member selecting/terminating
Label
MI
R
MI
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 15
Data
Middle Initial
O
Middle Initial of Assistance Group member selecting/terminating
Label
RSHIP
R
RSHIP
Data
Relationship to PIP
R
Relationship of Assistance Group member selecting/terminating to PIP. Use codes from Appendix I, Relationship Table
Label
SEX
R
SEX
Data
Sex
R
Sex of Assistance Group member selecting/terminating. Choose one: M = Male F = Female U = Unknown
Label
ADDINFO1
R
ADDINFO1
Data
Race
O
Race of the Assistance Group member selecting/terminating. Choose one: A = Asian B = Black or African American I = American Indian or Alaskan Native P = Native Hawaiian or Other Pacific Islander U = Unknown W = White
Label
ADDINFO2
R
ADDINFO2
Data
Ethnicity
O
Ethnicity of the Assistance Group member selecting/terminating. Choose one: H = Hispanic N = Non-Hispanic U = Unknown
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 16
Label
BDATE
R
BDATE
Data
Birth Date
R
Birth Date of Assistance Group member selecting/terminating, Format: MM/DD/YYYY
Label
MEDRECIPIENTID
R
MEDRECIPIENTID
Data
Medicaid Recipient ID
R
Recipient Billing Number, also called Medicaid Recipient ID (12 digit) of Assistance Group member selecting/terminating.
Label
DESPCP
R
DESPCP
Data
Desired PCP
O
Name of the Desired Primary Care Physician of Assistance Group member selecting/terminating.
Label
DESPCPMEDPROVNO
R
DESPCPMEDPROVNO
Data
Desired PCP Medicaid Provider Number
O
The desired PCP=s Medicaid Provider Number (7 digits)
Label
CRTPCPPAT
R
CRTPCPPAT
Data
Current PCP Patient
O
Current patient of the requested PCP, Format: T or F
Label
DESHOSP
R
DESHOSP
Data
Desired Hospital
O
Name of Desired Hospital of the Assistance Group member selecting/terminating
Label
SCREENSTATUS
R
SCREENSTATUS
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 17
Data
Status of Screen
C
Required if >Type of
Selection= = 01 or 04
Required if >Type of Selection= = 01 or 04. Choose one of the following: 01 = Screening resulted with at least one positive response 02 = Screen completed with zero positive responses 03 = Screen either not conducted or incomplete with zero positive responses
Label
MEDSCRNRESULT
R
MEDSCRNRESULT
Data
Screening for Medical Condition Code
O
Response of the potential members with Special Health Care Needs (SHCN) Screen for medical conditions. Use this field for all positive responses to the Medical Condition screening questions. Choose any combination from Condition Code Table, Appendix H, for example, if consumer responds positive to the Asthma question and also indicates they have two medical conditions, heart disease and allergies in response to the Medical Condition question, then 3 codes would be used in this field; 24, 21, 23. Choose codes from Appendix H, Condition Code Table. If the condition is not in the table or no specific condition is given, use 99 = Other and describe in >Other Medical Condition= field.
Label
OTHMEDSCRN
R
OTHMEDSCRN
Data
Other Medical Condition
C
Required if >Screening for
Medical Conditions Code== 99
If >Screening for Medical Conditions Code= = 99 = Other, use text to describe condition
Label
NONMEDSCRNRESULT
R
NONMEDSCRNRESULT
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 18
Data
Screening for Additional Assistance Code
O
Response of the CSHCN Screen for addition assistance Use 01, 02 or any combination. 01 = Receiving Supplemental Security Income (SSI) 02 = Current letter of approval from the Bureau of Children with Medical Handicaps
Label
SSOT
R
SSOT
Data
Scheduled Services or Ongoing Treatment(s)
O
Services already scheduled for this person, Format: T or F
Label
SRVTRT
R
SRVTRT
Data
Service or Treatment
C
Required if >Scheduled Services or Ongoing
Treatment(s)= = T
If >Scheduled Services or Ongoing Treatment(s)= = T, use text to describe the Service or Treatment that is scheduled (e.g., delivery, appendectomy)
Label
SRVTRTDATE
R
SRVTRTDATE
Data
Service or Treatment Date
O
Date of the scheduled service, if known Format: MM/DD/YYYY
Label
SRVTRTDOC
R
SRVTRTDOC
Data
Service or Treatment Doctor
O
Name of the doctor who will provide the scheduled service or treatment, if known
Label
OPOLICYINAME
R
OPOLICYINAME
Data
Other Policy Information Name
O
Name of other Medical Coverage
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 19
Label
OPOLICYINUM
R
OPOLICYINUM
Data
Other Policy Information Number
O
Number of other Medical Coverage & Policy
Label
ERCLASTNAME
R
ERCLASTNAME
Data
Emergency Contact Last Name
O
Last Name of Emergency Contact.
Label
ERCFIRSTNAME
R
ERCFIRSTNAME
Data
Emergency Contact First Name
O
First Name of Emergency Contact.
Label
ERCRSHIP
R
ERCRSHIP
Data
Emergency Contact Relationship
O
Relationship of the Emergency Contact to the Assistance Group Head. Use codes from Appendix I, Relationship Table.
Label
ERCHACODE
R
ERCHACODE
Data
Emergency Home Phone Area Code
O
Area Code of Emergency Contact, Format: ###
Label
ERCHPHONE
R
ERCHPHONE
Data
Emergency Home Phone Number
O
Home Phone Number of the Emergency Contact, Format: #######
Label
ERCBACODE
R
ERCBACODE
Data
Emergency Business Phone Area Code
O
Business Phone Area Code of the Emergency Contact
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 20
Label
ERCBPHONE
R
ERCBPHONE
Data
Emergency Business Phone Number
O
Business Phone Number of the Emergency Contact
Label
AUTHTOTRT
R
AUTHTOTRT
Data
Authorization to Treat
O
Authorization to Treat Minor Dependents (T or F)
Label
CALLERLASTNAME
R
CALLERLASTNAME
Data
Callers Last Name
O
Last name of the caller making the Selection/Change
Label
CALLERFIRSTNAME
R
CALLERFIRSTNAME
Data
Callers First Name
O
First name of the caller making the Selection /Change
Label
ENRSPECID
R
ENRSPECID
Data
Enrollment Specialist ID
O
ID of the person who made the Selection /Change
Label
CONTACTDATE
R
CONTACTDATE
Data
Date of Contact
O
Date the selection information was taken, Format: MM/DD/YYYY
Label
PROCDATE
R
PROCDATE
Data
Processed Date
O
Date transaction entered on CRIS-E, Format: MM/DD/YYYY
Label
PROCBYID
R
PROCBYID
Data
Processed By ID
O
ID of person who entered the transaction on CRIS-E
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 21
7.0 File Transfer and Retrieval Each MCP must retrieve CCR files through secure file transfer protocol (SFTP). There is a variety of client SFTP software available for this purpose. Client software requirements for SFTP:
• Allow authorization secure sockets listing (AUTH SSL). • Support SSL Listings. • Support SSL Transfers. • Connect to IP address: 156.63.17.11.
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 22
Below is an example of an FTP client application properly configured to connect to ODJFS’ SFTP server:
The example was taken from the Core FTP Lite application. To configure your specific FTP client software, refer to the documentation provided with that software from the manufacturer.
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 23
Appendix A
Submitter ID Table
Submitter ID Plan
293 Anthem Blue Cross Blue Shield Inc.
305 WellCare
315 CareSource
325 Paramount Advantage
420 Buckeye Community Health Plan
712 AMERIGROUP Ohio Inc.
731 Molina HealthCare of Ohio Inc.
755 Gateway Health Plan of Ohio Inc.
761 Unison Health Plan Ohio Inc.
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 24
Appendix B
County Code Table
01 Adams 02 Allen 03 Ashland 04 Ashtabula 05 Athens 06 Auglaize 07 Belmont 08 Brown 09 Butler 10 Carroll 11 Champaign 12 Clark 13 Clermont 14 Clinton 15 Columbiana
16 Coshocton 17 Crawford 18 Cuyahoga 19 Darke 20 Defiance 21 Delaware 22 Erie 23 Fairfield 24 Fayette 25 Franklin 26 Fulton 27 Gallia 28 Geauga 29 Greene 30 Guernsey
31 Hamilton 32 Hancock 33 Hardin 34 Harrison 35 Henry 36 Highland 37 Hocking 38 Holmes 39 Huron 40 Jackson 41 Jefferson 42 Knox 43 Lake 44 Lawrence 45 Licking
46 Logan 47 Lorain 48 Lucas 49 Madison 50 Mahoning 51 Marion 52 Medina 53 Meigs 54 Mercer 55 Miami 56 Monroe 57 Montgomery 58 Morgan 59 Morrow 60 Muskingum
61 Noble 62 Ottawa 63 Paulding 64 Perry 65 Pickaway 66 Pike 67 Portage 68 Preble 69 Putnam 70 Richland 71 Ross 72 Sandusky 73 Scioto 74 Seneca 75 Shelby
76 Stark 77 Summit 78 Trumbull 79 Tuscarawas 80 Union 81 Van Wert 82 Vinton 83 Warren 84 Washington 85 Wayne 86 Williams 87 Wood 88 Wyandot
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Appendix C
Assignment Code Table
Code
Description of Assignment Process
00
MCP enrollment (involuntary disenrollment); choose last MCP
01
No FFS PCP experience within 1 year and no MCP experience within 1 year; choose best MCP provider panel (PCP only for CFC, additional provider types for ABD)
02
FFS PCP experience within 1 year without MCP experience within 1 year; no MCP match to PCP; choose best MCP provider panel (PCP only for CFC, additional provider types for ABD)
03
FFS PCP experience within 1 year without MCP experience within 1 year; only one MCP match to appropriate provider type; choose matching MCP
04
FFS PCP experience within 1 year without MCP experience within 1 year; 2 or more MCP matches to appropriate provider type; among matching MCPs, choose best MCP provider panel (PCP only for CFC, additional provider types for ABD)
05
FFS PCP experience within 1 year with MCP experience within 1 year with involuntary disenrollment; MCP experience more recent; choose most recent MCP
06
FFS PCP experience within 1 year with MCP experience within 1 year with involuntary disenrollment; 1 FFS visit more recent; choose most recent MCP
07
FFS PCP experience within 1 year with MCP experience within 1 year with involuntary disenrollment; 2 or more FFS visits more recent; no MCP match to PCP; choose most recent MCP
08
FFS PCP experience within 1 year with MCP experience within 1 year with involuntary disenrollment; 2 or more FFS visits more recent; only one MCP match to PCP; choose matching MCP
FFS PCP experience within 1 year with MCP experience within 1 year with involuntary
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09 disenrollment; 2 or more FFS visits more recent; 2 or more MCP matches to appropriate provider type, one of which is MCP of last enrollment; choose last MCP
10
FFS PCP experience within 1 year with MCP experience within 1 year with involuntary disenrollment; 2 or more FFS visits more recent; 2 or more MCP matches to PCP, none of which is MCP of last enrollment; among matching MCPs, choose best MCP provider panel (PCP only for CFC, additional provider types for ABD)
11
Assistance Group not listed on Assignment Utilization File; choose best MCP provider panel (PCP only for CFC, additional provider types for ABD)
99
OTHER
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Appendix D
MANAGED CARE PROGRAM CRIS-E ENROLLMENT TABLE REASON CODES
Code
Description
Voluntary
ARE
AUTO-REENROLLMENT
N
ASG
ASSIGNMENT
N
EAS
CORRECTION COMPLETED BY EAS
N
VOL
VOLUNTARY ENROLLMENT
Y
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Appendix E
MANAGED CARE PROGRAM CRIS-E DISENROLLMENT TABLE REASON CODES
Code
Description
Voluntary
ADE
AUTO-DISENROLLMENT
N
CCD
CONTINUITY OF CARE – OTHER
Y
CCP
CONTINUITY OF CARE – PREGNANT
Y
CCS
CONTINUITY OF CARE – PRE-SCHEDULED SURGERY
Y
CCT
CONTINUITY OF CARE – ONGOING TREATMENT
Y
CIC
CHILDREN IN CUSTODY
N
DCT
DISENROLLMENT DUE TO CASE TRANSFER
N
DEF
INPATIENT DEFERMENT
N
ERS
RECONCILIATION BY EAS
N
EVF
RETURN TO FFS BY EAS
N
INC
INCARCERATION
N
JCH
MEMBERSHIP HARMFUL TO MEMBER/ODJFS DETERMINATION
Y
JCI
CONSUMER MOVED OUT OF MCP’S SERVICE AREA
Y
JCK
SERVICES NOT COVERED DUE TO MORAL OR RELIGIOUS OBJECTIONS OF MCP
Y
JCL
LANGUAGE BARRIER
Y
JCP
RELATED SERVICES NEEDED
Y
JCQ
LACK OF ACCESS TO SERVICES/EXPERIENCED/PROVIDER
Y
LOC
LEVEL OF CARE DETERMINATION/NURSING HOME PLACEMENT
N
MCA MCP INITIATED/UNCOOPERATIVE OR DISRUPTIVE BEHAVIOR
N
MCF
MCP INITIATED –FRAUDULENT BEHAVIOR
N
MTT
MEMBERSHIP TERMINATION DUE TO CASE TRANFER
N
MEX
MEMBERSHIP EXCLUSION
Y
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MLC MCP LEAVING COUNTY N
NIA PRIMARY CARE PROVIDER NOT ON MCP PROVIDER PANEL
Y
NIB
PRIMARY CARE PROVIDER LEFT MCP PROVIDER PANEL
Y
NID
LIKES EXTRA SERVICES OF NEW MCP BETTER
Y
NIE
DOESN’T LIKE PCP OR SPECIALIST
Y
NIF
SERVICES DENIED
Y
NIG
SERVICES NOT COVERED
Y
NIH
PAYMENT OF CLAIM DENIED
Y
NII
DIFFICULT TO REACH PCP/SPECIALIST
Y
NIJ
DENTIST NOT ON MCP PROVIDER PANEL
Y
NIK
DENTIST NO LONGER ON MCP PROVIDER PANEL
Y
NIL
HOSPITAL NOT ON MCP PROVIDER PANEL
Y
NIM
HOSPITAL NO LONGER ON THE MCP PROVER PANEL
Y
NIN
OB/GYN NOT ON MCP PROVIDER PANEL
Y
NIO
OB/GYN NO LONGER ON THE MCP PROVIDER PANEL
Y
NIP
PREFERS MEDICAID CARD/DIFFERENT MCP
Y
NIQ
SPECIALIST NOT ON MCP PROVIDER PANEL
Y
NIR
SPECIALIST LEFT THE MCP PROVIDER PANEL
Y
NIS
NO REASON GIVEN FOR CHANGE
Y
TPL
THIRD PARTY LIABILITY/COVERAGE
Y
WAD
WAIVER ELIGIBLE BUT DENIED DUE TO NO SLOTS AVAILABLE
N
WAI
WAIVER ELIGIBLE/CORE PLUS
N
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Appendix F Change Reason Code
99
Other
Please note that all reasons are listed on Appendix D and Appendix E until further notice.
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Appendix G Primary Language Indicator Table
Code Language AFR
AFRIKAAN
ALB
ALBANIAN
AMH
AMHARIC (Ethiopia)
ARA
ARABIC (Middle East)
ARM
ARMENIAN
BAS
BASQUE
BEL BELORUSSIAN (Belarus) BEN
BENGALI (Bangladesh)
BUL
BULGARIAN
BUR
BURMESE
CAM
KHMER (Cambodian)
CAN
CANTONESE (Hong Kong)
CHI
MANDARIN (China-Simplified)
CHT
MANDARIAN (China-Traditional)
CRO
CROATIAN
CZE
CZECH
DAN
DANISH
DUT
DUTCH
ENG
ENGLISH
EST
ESTONIAN
FAR
FARSI (Afghanistan)
FIN
FINNISH
FLE
FLEMISH
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FRC
FRENCH CREOLE
FRE
FRENCH (France)
GER
GERMAN (Germany)
GRE
GREEK
HAI
HAITIAN
HEB
HEBREW (Israel)
HIN
HINDI
HMO
HMONG
HUN
HUNGARIAN
ICE
ICELANDIC
IND
INDIC
IRA
FARSI (Iran)
ITA
ITALIAN (Italy)
JAP
JAPANESE (Japan)
KOR
KOREAN (Korea)
KUR KURDISH (Northern Iraq)
KU1 KURDISH (Southern Iraq) LAO
LAOTIAN (Laos)
LAT
LATVIAN
LIT
LITUANIAN
MAC
MACEDONIAN (Macedonia)
MON
MON-KHMER
NOR
NORWEGIAN
ORO
OROMO (Ethiopia)
OTH
OTHER
PAK
PAKISTAN
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POC
PORTUGUESE CREOLE
POL
POLISH
POR
PORTUGUESE (Brazil, Portugal)
PUN
PUNJABI
ROM
ROMANIAN
RUS
RUSSIAN (Russia)
SER
SERBIAN
SLO
SLOVAK
SLV
SLOVENIAN
SOM
SOMALI (Somalia)
SPA
SPANISH
SPE
SPANISH/ENGLISH BILINGUAL
SWA
SWAHILI (Tanzania)
SWE
SWEDISH
TAG
TAGALOG
THA
THAI (Thailand)
TIG
TIGENYA (Eritrea)
TUR
TURKISH (Turkey)
UKN
UKNOWN
UKR
UKRANIAN (Ukraine)
VIE
VIETNAMESE
YDD
YIDDISH (Yiddish)
Consumer Contact Record File Specifications Bureau of Managed Health Care
October 2006 34
Appendix H
Condition Code Table
ODJFS CONDITION CODE
DESCRIPTION
02
HIV/AIDS
03
Cancer
04
Leukemia
06
Cystic Fibrosis
07
Diabetes
09
Hemophilia
10
Sickle Cell
11
Mental Disorders (except Depression, Anxiety, Schizophrenia)
12
(ADD/ADHD) Attention Deficit Disorder/Attention Deficit Hyperactive Disorder
13
Alcohol and other Drug Abuse
14
Post Traumatic Brain Injury
16
Cerebral Palsy
17
Chronic Otitis Media
18
Epilepsy
19
Muscular Dystrophy
21
Heart Disease
23
Allergies
24
Asthma
28
Chronic Renal Failure
30
Teen/Adult Pregnancy
33
Arthritis
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ODJFS CONDITION CODE NUMBER
DESCRIPTION
35 Cleft Palate
36
Hydrocephalus
37
Spina Bifida
41
Burns
42
Lead Poisoning
43
Trauma
111 Anxiety Disorders
114 Depression
116 Mental Retardation
117 Schizophrenia
126 Cardiovascular Disease
127 Congestive Heart Failure (CHF)
128 Coronary Artery Disease (CAD)
129 Hypertension
130 Stroke
134 Chronic Obstructive Pulmonary Disease (COPD)
99 Other
Note: The conditions listed in this table are common conditions with common names for use by those with no clinical expertise. The conditions in this table were taken from a more extensive list of conditions. For this reason, the codes do not start with 01 and do not increase incrementally.
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October 2006 36
Appendix I Relationship Table
Code
Description
AUN
Aunt
BTR
Brother
DAU
Daughter
FCO
First Cousin
FRD
Friend
FTR
Father
GDS
Grandson
GGD
Great Granddaughter
GGF
Great Grandfather
GGM
Great Grandmother
GGS
Great Grandson
GRD
Granddaughter
GRF
Grandfather
GRM
Grandmother
HBR
Half Brother
HSR
Half sister
HUS
Husband
MTR
Mother
NEI
Niece
NEP
Nephew
NIE
Niece
OTR
Other Specified Relative
SLF
Same Person
SON
Son
SPO
Sponsor